1477842409 NPI number — DIVERSE SPEECH THERAPY SOLUTIONS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477842409 NPI number — DIVERSE SPEECH THERAPY SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVERSE SPEECH THERAPY SOLUTIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477842409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78217-0465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-381-7534
Provider Business Mailing Address Fax Number:
210-592-7366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1804 NE LOOP 410
Provider Second Line Business Practice Location Address:
220
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78217-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-829-5777
Provider Business Practice Location Address Fax Number:
210-829-5972
Provider Enumeration Date:
03/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BATTIATO
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SINGLE MEMBER/SLP
Authorized Official Telephone Number:
210-381-7534

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  19156 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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